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Pregnancy Risk Factors | 마이메르시 MyMerci
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Pregnancy Risk Factors

NCLEX Review Guide: Maternal Newborn Health - Prenatal Period Risk Factors

High-Risk Pregnancy Conditions

Maternal Age Risk Factors

  • Advanced maternal age (≥35 years) increases risk for chromosomal abnormalities, gestational diabetes, hypertension, and multiple gestations. Down syndrome risk increases from 1:1,250 at age 25 to 1:400 at age 35.
  • Adolescent pregnancy (<18 years) carries higher risks for preterm labor, low birth weight, pregnancy-induced hypertension, and inadequate prenatal care due to psychosocial factors.

Pre-existing Medical Conditions

  • Diabetes mellitus requires strict glucose control to prevent congenital anomalies, macrosomia, and maternal complications. Target HbA1c <7% preconceptionally and <6% during pregnancy.
  • Hypertension increases risk for preeclampsia, placental abruption, and intrauterine growth restriction (IUGR). ACE inhibitors are contraindicated; methyldopa is first-line treatment.
  • Cardiac disease classification uses NYHA functional class; Class III-IV requires specialized care with potential for maternal mortality up to 25-50%.

Key Points

  • Folic acid 400-800 mcg daily prevents neural tube defects when started preconceptionally
  • Teratogenic medications must be discontinued before conception when possible
  • Genetic counseling recommended for advanced maternal age or family history

Pregnancy-Induced Complications

Hypertensive Disorders

  • Gestational hypertension develops after 20 weeks with BP ≥140/90 on two occasions, 4 hours apart, without proteinuria or end-organ damage.
  • Preeclampsia includes hypertension plus proteinuria (≥300mg/24hr) or severe features like headache, visual changes, epigastric pain, or thrombocytopenia.
  • HELLP syndrome represents severe preeclampsia with Hemolysis, Elevated Liver enzymes, and Low Platelets - requires immediate delivery regardless of gestational age.

Clinical Scenario

A 28-year-old G2P1 at 34 weeks presents with severe headache, blurred vision, and epigastric pain. BP 160/110, proteinuria 3+, platelets 90,000. This indicates severe preeclampsia requiring magnesium sulfate for seizure prophylaxis and delivery planning.

Gestational Diabetes Mellitus (GDM)

  • Screening occurs at 24-28 weeks using 1-hour glucose challenge test; values ≥140 mg/dL require 3-hour glucose tolerance test for diagnosis.
  • Maternal complications include increased cesarean delivery risk, future type 2 diabetes development, and recurrent GDM in subsequent pregnancies.

Key Points

  • Magnesium sulfate is first-line treatment for eclampsia prevention and treatment
  • GDM requires fasting glucose <95 mg/dL and 2-hour postprandial <120 mg/dL
  • Delivery timing depends on maternal condition and fetal well-being assessment

Commonly Confused Concepts

Hypertensive Disorders Comparison

ConditionOnsetBP CriteriaProteinuriaAdditional Features
Chronic HTNPre-pregnancy or <20 weeks≥140/90May be presentPre-existing condition
Gestational HTN>20 weeks≥140/90AbsentNo severe features
Preeclampsia>20 weeks≥140/90≥300mg/24hr OR severe featuresEnd-organ involvement
EclampsiaAny timeVariableUsually presentSeizures

Memory Aid: HELLP Syndrome

Hemolysis - schistocytes on blood smear
Elevated Liver enzymes - AST >70 U/L
Low Platelets - <100,000/μL

Study Tips & Assessment

NCLEX Priority Framework

  1. Assess maternal vital signs and fetal heart rate first
  2. Implement safety measures (seizure precautions for preeclampsia)
  3. Administer medications as ordered (magnesium sulfate, antihypertensives)
  4. Monitor for complications and notify physician of changes
  5. Provide patient education and emotional support

Common Pitfalls

  • Don't confuse gestational hypertension with preeclampsia - proteinuria or severe features distinguish preeclampsia
  • Remember magnesium sulfate toxicity signs: absent deep tendon reflexes, respiratory depression <12/min, decreased urine output
  • GDM screening timing is 24-28 weeks, not first trimester like other routine labs

Quick Self-Check

I can differentiate between types of hypertensive disorders in pregnancy
I understand risk factors for high-risk pregnancies
I know the management priorities for preeclampsia
I can identify signs of magnesium sulfate toxicity

Remember: You're preparing to be an advocate for mothers and babies. Every concept you master brings you closer to providing safe, competent care. Trust your preparation and clinical judgment - you've got this! 💪

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